30例异基因造血干细胞移植受者移植后ABO血型抗原和抗体效价的变化

摘要

Objective:To perform clinical monitoring on the changes of the ABO antigen and antibody titers of the patients after allogeneic HSCT,and provide references for the transfusion support treatments of the HSCT.Methods:The ABO blood types of 30 HSCT recipients with matched HLA and different ABO blood type antigens were identified.Two patients were selected for monitoring on changes of their ABO antigen intensity and antibody titers in the 1st,2nd,3rd,4th,5th,7th,8th,10th weeks after transplantation.Results:The recipients' blood antigen types shifted to the types of the donors after transplantation in all the 30 pairs with different ABO blood type antigens.Among these,the blood type antigens of the recipients who had unmatched types either in primary or secondary side shift at the fourth week after transplantation.The blood type antigens of the recipients who had unmatched types only in secondary side shift at the 7th week after transplantation.In the pairs who had unmatched types only in the primary side,the results of the positive and negative typing are compatible; in the pairs who had unmatched types only in the secondary side,the agglutinins (anti B or anti A) were detected in the serum at 8th week and the antibody titer was 1:4.In the pairs with unmatched types either in primary or secondary side,no agglutinins were detected after the transplantation,the incompatible results of the positive and negative typing were founded.Conclusion:The donor-recipient pairs with matched HLA need to be established in the allogeneic HSCT transplantation.The red cells which would not be agglutinated by the recipients' serum antibodies and not contain the corresponding antigens,and the platelet and plasma which would not contain the corresponding antibodies in the donors' serum should be selected for the transfusion in the blood transfusion.%目的:对异基因HSCT对受者ABO抗原和抗体效价的变化进行临床监测,为HSCT移植的输血支持治疗提供参考依据.方法:对30例HLA配型相合、ABO血型抗原不合的HSCT受者的移植前后进行ABO血型鉴定;选取其中2名患者,在移植后第1、2、4、5、7、8、10周检测其ABO血型抗原强度和抗体效价的变化.结果:所有30例ABO血型抗原不合的配对,移植后受者的血型抗原转变为供者的血型抗原,其中,主次侧均不合的配对在移植后第4周血型抗原发生转变,仅次侧不合的配对在移植后第7周血型抗原发生转变;仅主侧不合的配对,移植后的正反定型结果相符;仅次侧不合的配对,第8周血清中可检出凝集素(抗B或抗A)、抗体效价为1:4;主次侧均不合的配对,移植后血清中未检出凝集素,且出现了正反定型结果不相符的结果.结论:异基因HSCT移植,应尽量选择HLA配型相合的受者-供者配对,输血时应选择不被受者血清中抗体所凝集的红细胞并不含相应抗原,以及供者血清中不含相应抗体的血小板或血浆进行输注.